Sahu Avilash, Manekar Aditya Arvind, Sahoo Subrat Kumar, Tripathy Bikasha Bihary, Mohanty Manoj Kumar
Department of Paediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
J Indian Assoc Pediatr Surg. 2025 May-Jun;30(3):317-321. doi: 10.4103/jiaps.jiaps_229_24. Epub 2025 Mar 3.
Adrenal tumors account for 0.2%-1% of all tumors in children. They can be benign or malignant, secretory or nonsecretory, and can arise either from the cortex or medulla. The common indication in children undergoing laparoscopic adrenalectomy (LA) is neuroblastic tumors (neuroblastoma, ganglioneuroma, and ganglioneuroblastoma).
This is a retrospective observational study conducted from October 2021 to February 2024 (28 months) in the pediatric surgery unit at our institute. All children under 18 years of age referred to us for surgery of adrenal mass were included in this study. Any children with image-defined risk factors (IDRFs + ve) were excluded from the study. Children were worked up and managed according to the protocol of the Institute Pediatric Tumor Board. The laparoscopic transperitoneal approach was used for all. All adrenal lesions with IDRF +ve were excluded from the study and resected via open approaches.
A total of six patients were included (three each in male and female groups). The mean age was 31 months (range 22 months-39 months). There were two cases of neuroblastoma, and one each of pheochromocytoma, adrenal adenoma, adrenocortical carcinoma, and paraganglioma. The median follow-up period was 24 months (range 7-32 months). On follow-up, there are no recurrences reported till date with zero mortality.
LA is a safe and feasible operation in children without any IDRF. It should be preferred in children with small lesion with good plane between the tumor and normal tissues. For larger lesion and ACC, it should be used cautiously to prevent spillage. Thought difficult, laparoscopic resection is a safe approach for these adrenal tumors.
肾上腺肿瘤占儿童所有肿瘤的0.2%-1%。它们可以是良性或恶性、分泌性或非分泌性的，可起源于皮质或髓质。接受腹腔镜肾上腺切除术（LA）的儿童的常见指征是神经母细胞瘤性肿瘤（神经母细胞瘤、神经节瘤和神经节神经母细胞瘤）。
这是一项于2021年10月至2024年2月（28个月）在我们研究所的小儿外科进行的回顾性观察研究。所有18岁以下因肾上腺肿块前来我们这里接受手术的儿童均纳入本研究。任何有影像定义风险因素（IDRFs阳性）的儿童均被排除在研究之外。儿童按照研究所儿科肿瘤委员会的方案进行检查和管理。所有病例均采用腹腔镜经腹入路。所有IDRF阳性的肾上腺病变均被排除在研究之外，并通过开放手术切除。
共纳入6例患者（男女组各3例）。平均年龄为31个月（范围22个月至39个月）。有2例神经母细胞瘤，嗜铬细胞瘤、肾上腺腺瘤、肾上腺皮质癌和副神经节瘤各1例。中位随访期为24个月（范围7至32个月）。随访至今，未报告复发，死亡率为零。
LA对于没有任何IDRF的儿童是一种安全可行的手术。对于肿瘤与正常组织之间界限清晰的小病灶儿童应优先选择。对于较大病灶和肾上腺皮质癌，应谨慎使用以防止肿瘤播散。尽管困难，但腹腔镜切除术对于这些肾上腺肿瘤是一种安全的方法。
